Wednesday, February 3, 2010

The Tea Baggers Just May Have a Point About Health Care.....

Back in the 1960s, the Twilight Zone regaled television viewers with fantastic stories from a place between 'science and superstition,' that lay 'between the pit of man's fears and the summit of his knowledge.' Approximately thirty years later, popular culture was introduced to an even more surreal place in the 1979 film The Black Hole. Disney's state-of-the-art special effects portrayed a space environment dominated by a distant, visually compelling and vaguely sinister hyper-gravitational spinning black hole. As testimony to their commercial success, the terms 'twilight zone' and 'black hole' remain instantaneously recognizable today, describing situations where the usual laws of gravity, time and common sense are unpredictably and variably suspended.

Since thirty years have passed, it may be time to recognize another fantastical environment, described in this Health Affairs web exclusive, titled 'Prices Don’t Drive Regional Medicare Spending Variations,' by Daniel Gottlieb, Weiping Zhou, Yunjie Song, Kathryn Gilman Andrews, Jonathan Skinner and Jason M. Sutherland.

Basically, the authors examined critical three factors in the regional variation of Medicare's per capita health spending: 1) the additional money allocated for teaching hospitals, 2) the additional money allocated for the care of the socioeconomically disadvantaged and 3) local differences in the cost of living, which influences pricing of medical services. The bottom line is that when these elements are mathematically 'backed out,' per capita variation in health care spending is only dampened sightly and is still all over the board.

How can this be?

While it's still up to readers to decide if some of the variation can be explained by local poverty and its effect on hospital quality, the Disease Management Care Blog is still struck by Medicare's surreal distortion of the time-space fabric of the health care market universe and how easily the viewer can be sucked into this logic-defying time-space of contractors, DRGs, RVUs, ineffective cost controls, inefficient mainframe-style central planning, political zg zagging, cumbersome denials, attacking the inevitable outliers, provider gaming and a sprawling $911 billion bureaucracy.

There is plenty of blame to go around for this dysfunction and, let's face it, Medicare and Medicaid have led to unparalleled health benefits for the poor and elderly. Yet, persons looking into the distorted market of two to threefold cost differentials with no discernible impact on quality must be puzzled by how the black hole can bend a line of reasoning toward greater government involvement.

The DMCB not suggesting the CMS be cancelled, any more than it can cancel black holes: both are embedded in our time-space continuum.

But it also cautions against tut-tutting those wacky cranky Tea Baggers and their common sense look at 'government style health care.' The cognitive dissonance of 'getting government out of Medicare' belies a deeper reality: once you step outside the Twilight Zone and away from the Black Hole, it's pretty obvious that government's management of the program is not of this earth.

No comments: